Carl Heneghan

Yes, hi, I am Carl Hennigan.

I'm editor-in-chief of BMJ Evidence-Based Medicine and professor of EBM at the University of Oxford and a general practitioner.

I like how you've stuck with that.

I think, though, with the coronavirus, you may have to... I might be called up.

prescribing yeah i found this quite an interesting issue but i think it's a nice start but there's a lot of bits of information missing in the paper because it just gives us a headline figure one percent of prescribers are responsible for all the problems but we know that's not the case because there can be clear reasons why you're in that high level and we looked at this in sometimes in terms of deaths

And people start saying deaths cluster in 1% of GPs or 1% of family docs, but they're all the ones that have palliative care and nursing homes under their wing.

Interestingly here as well, it picks out one of the indications as back problems.

But I think it's interesting when you see back problems, often people have tried a lot of intervention.

So they've tried the paracetamol, they've tried the non-steroidal.

And they want to get moving and it's debilitated.

So you're at that crux where you are at.

We're going to go to the codeine now because we want to get you moving.

So I think there's a lot more to be drawn out in this paper to help us understand what we should and shouldn't do.

My position is to say if I'm going to prescribe them in these indications, it's only to give a short duration of use so that you don't get beyond the three to five days and you're still on them and actually have got better, but the problem is you don't want people to get addicted.

But I think there's an interesting point.

One of the big things in America is the...

opiate sort of a crisis is the number of deaths being caused by opioid prescriptions but there's a real interesting caveat as you solve one problem then another problem emerges and in the back of the discussion they say that actually there's been a recent increase in deaths from illicit opioids as an unintended consequence of reducing the availability of medical prescribed opioids more people are going on to substitutes are going on to heroin and actually they're far more

serious and far more potent and are giving rise to more deaths.

So it's not quite as straightforward as this.

If you reduce this, you'll solve all the problems here.